Shelto: Rebuilding our behavioral health care system

By Audrey Shelto/Guest Columnist

Sunday

Mar 31, 2019 at 3:55 AMApr 9, 2019 at 12:20 PM

Twelve years ago, the leaders of our commonwealth came together in acknowledgment that our health care system was failing the residents, too many of whom were uninsured or had limited coverage. What ensued was the most comprehensive and groundbreaking state health reform initiative in the nation’s history. Today, 96 percent of the state’s adults are insured. So are 99 percent of Massachusetts children, the highest rate in the nation.

Health coverage, however, does not guarantee access to care, and that is particularly true for people who need care for mental illness and substance use disorders. More than half of insured adults who sought care for mental health and/or substance use disorders – frequently called behavioral health care – reported difficulty in obtaining that care over the past year. More than half of our youth who experienced a major depressive episode received no mental health services.

Despite Massachusetts having a relatively high number of behavioral health service providers, our system of caring for people with these conditions is falling short. I would actually argue there is no system at all.

For it to be called a system, it would need to be built around the care needs of the individual or family – what we call person-centered – and would allow people to connect to an appropriate level of care, regardless of their point of entry. Instead, individuals needing help must work within the rigid confines of our existing care structure to get help. Too often, they don’t make it past the front door.

When thinking about barriers to behavioral health care, look no further than urgent care. For physical illnesses and injuries that are not emergencies but happen outside of the normal hours of a doctor’s office, many people can be assessed and treated by an urgent care center in a timely way. For those with a behavioral health condition, there are times when an individual is not in crisis but may need care more quickly than the days, weeks or even months it might take to get an appointment. More often than not, the only door available to them is the one to the emergency department.

These disparities are wrong and they perpetuate the stigma that has surrounded mental health for too many years.

Causes of the current system breakdown include:

Difficulty in navigating a complicated and uneven system of care, particularly in areas where there are fewer available providers, as well as a lack of urgent or intermediate care.

Workforce shortages, caused by a tight labor market, that are creating a capacity crisis across the system and are compounded by some providers’ non-acceptance of insurance payments.

Different insurance plans covering different services so there is an overall lack of consistency in coverage.

A lack of affordable and stable housing, which harms those struggling with behavioral health issues by adding barriers to treatment and recovery.

Fortunately, a plan now exists for fixing the system.

Earlier this year, our foundation released a report by Manatt Health that maps out the problems with the existing system and creates a blueprint for improving it. The process included using a vision of a true system of care that is accessible to all, adequately staffed and funded, whole-person responsive, and quality-outcomes driven.

The plan includes next steps toward making it easier for people experiencing mental illness and substance use disorder to gain access to the behavioral health care system, including:

Increasing the number of primary care providers who are able to screen for behavioral health concerns and appropriately connect those at risk into prevention and treatment.

Expanding the use of telemedicine, which can connect people in rural areas to care and improve access to the limited number of specialists such as psychiatrists and others who can prescribe medication.

Creating more same-day and walk-in capacity for outpatient behavioral health services through changes to the way providers are paid for these services.

We can’t will our way to a better functioning behavioral health system. We must rebuild our system from the ground up, saving what works, tweaking what doesn’t and removing the barriers that stand between people and care. Success will require our elected officials, business and health care leaders, advocates and consumers to come together and create the accessible, high-quality system of behavioral health care that we all want and that the residents of Massachusetts deserve.

We need it now more than ever. As we deal with the opioid epidemic that continues to grip our region and nation, as well as elevated levels of anxiety, depression and other mental health conditions, we must fulfill our obligations to those who need care.

As a commonwealth, we are proud of what we have accomplished. We assert our rightful place as the birthplace of health reform. The challenge before us now is providing for the nation an example of an accessible and comprehensive behavioral health system.

Audrey Shelto is president of the Blue Cross Blue Shield of Massachusetts Foundation, a private, nonprofit organization whose mission is to expand access to health care for low-income and vulnerable people in the commonwealth.